This practice is common in European countries where a pharmacist is allowed to "prescribe" and sell medications.

Under the changes that the agency is considering, patients could diagnose their ailments by answering questions online or at a pharmacy kiosk in order to buy current prescription-only drugs for conditions such as high cholesterol, certain infections, migraine headaches, asthma or allergies.

By removing the prescription requirement from popular drugs, theObama administration could ease financial pressures on the overburdened Medicare system by paying for fewer doctor visits and possibly opening the door to make seniors pay a larger share of the cost of their medications.

So how about birth control pills, or E.D. medication?

And since this is the government, don't you find it odd that you may be able to purchase medication without a doctor's prescription but if you want to purchase OTC medication and have it covered by your HSA you need a prescription?

The owner of the Fawlty Towers motel in Cocoa Beach has been unable to pay his bills due to increased competition from larger, chain motels. In an attempt to save his business, starting tomorrow (May 1, 2012) the motel will be clothing optional.

Going nude wasn't a snap decision. Owner Paul Hodge first had to convince his skeptical wife. And he has yet to sway some of his concerned neighbors, who fear the soon-to-be nude motel will expose tourists, and local children, to some unwanted sightseeing.

His wife didn't like the idea? Gosh, who would have thought?

To prepare for his guests to bare all, Hodge hired a lawyer and consulted with the American Association of Nude Recreation. They apparently found no state or local laws that would stand in the way of Hodge's plan for unabashed indoor nudity.While that may be the case for Hodge's nude motel, other business owners may want to think twice before adding a naked twist to their business plans. Nudity may reclassify your business as "sexually oriented" (as one nude maid service in Texas recently found out), and may require new permits.

So what has all this got to do with health insurance?

Glad you asked.

Hodge says his nude motel plan is all about his bottom line. "It's sort of a make-or-break situation," he told Florida Today. "We can't pay ourselves in winter. We had to scrap health insurance.

See?

And you thought we just posted this to appeal to prurient interests . . .

Maternity insurance at Costco? You can buy a 5 pound bag of potato chips, 30 rolls of toilet paper and now in some states you can also buy health insurance. But can you get it with maternity insurance?

Business Insider offers this information about their health insurance, including maternity insurance.

In partnership withAetna,Costcowill dole out the Costco Personal Health plan in several states,according to a company press release – Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas, and Virginia, with more to be added later in the year.

Costco is following the path of Wal-Mart by offering health insurance to their members but do you really get a good deal?

The short answer is, no.

A quick check on Georgia health insurance from Costco including maternity insurance resulted in this finding.

They only offer health insurance through Aetna.

Aetna does not offer maternity insurance coverage. In fact, they never have included maternity insurance as an option.

They only offer 5 plans in Georgia. If you really wanted health insurance from Aetna you can buy it through a Georgia insurance agent and have access to 10 different plans.

The rates for the Costco health insurance plan are slightly less but the coverage has been stripped. In other words, you get less coverage for a lower premium.

Well duh!

The less expensive plans (read higher deductible) do not cover ANY brand name drugs. One plan covers brand Rx only after a $4,000 deductible.

-There is NO maternity care, unless you incur "pregnancy complications."This could be a major deterrent for many consumers, especially considering how important families must be to business.

-Deductibles are sky-high, which is unfortunately a growing trendfor private health care plans. For individuals, they range from $3,000 to $7,500 for in-network care and $6,000 to $10,000 for out-of-network care. For families, deductibles start from $6,000 to $15,000 for in-network and $12,000 to $20,000 for out-of-network care.

Here's a clue to the folks at Business Insider. After Obamacare was signed all Georgia carriers stopped offering maternity insurance except one (BCBSGA). And don't forget that Aetna NEVER offered maternity insurance as an option.

Costco consumers who apply for insurance with Aetna will have to go through medical underwriting which means your premium can increase or you can be turned down.

Costco is a great place to shop for toilet paper but you can do much better on health insurance and your local insurance agent can show you maternity insurance options as well.

Every couple of years, we're required to do a remedial "Anti-Money Laundering" (AML) course. Basically, it's to remind us to be alert for "suspicious" activity, such as large cash deposits on life policies (among other "red flags"). It's a licensing requirement, and isn't really a big deal (given online, takes maybe a half hour, tops).

I don't think I've ever had a client come in and pay actual cash for a policy, let alone a thousand dollars (the threshold). Still, I want to keep my license, so I do the course as required.

Reason I bring this up is because of a notice I received today from my primary carrier. Towards the end, it says this:

"For your clients who cannot provide and ID, do not proceed until you call [the compliance official] ... Please do not notify your client or give any indication that he or she is being investigated for suspicious activity." [emphasis in original]

Here's the problem: as an independent agent, I represent the carrier, but I work for the client. This instruction puts me in an uncomfortable - perhaps untenable - position: is my first duty to the carrier (and/or the law) or my client? The actual "red flag" in this instance is that I'm supposed to see an official photo ID (driver's license, passport, etc) when dealing with folks whom I do not know who proffer large sums of cash. The key there is "whom I do not know;" that is, if a long-time client and current policyholder walks in with a wad of $100's, well that's different from a total stranger in that circumstance.

Even so, if they're in my office to buy a policy, then aren't they now my client? And how does that comport with my duty not to disclose?

I really don't know what I would do in that scenario, and that is indeed a major conundrum.

The 10 carriers that participated in the survey said they paid $6.6 billion to a total of about U.S. 200,000 policyholders in 2011.

The customer with the biggest open claim is a woman who bought a policy when she was 43, went on claim 3 years later, and at last report, had been receiving benefits for more than 14 years. She paid $881 in premiums per year for 3 years before she stopped paying premiums because she was receiving policy benefits.

The man with the second largest known open claim paid annual premiums of $3,374 for 3 years, went on claim, and now has received $1.2 million in benefits over 6 years, AALTCI says.

AALTCI found that the 5 most common reasons for a policyholder to file a long term care insurance claim are Alzheimer's disease, stroke, arthritis, circulatory issues and injury.

There was an interesting article in Friday's Plain Dealer regarding lung cancer screening. The real gem though was an indisputable example of consumerism working in healthcare and why PPACA's preventive coverage requirements are such a terrible idea.

"Last June, University Hospitals Seidman Cancer Center began
offering $99 lung cancer screenings for people who have a referral from
their primary physicians. On Monday the Cleveland Clinic Respiratory Institute
will begin offering screenings for $125."

"UH and the Clinic offer low-dose CT at prices significantly lower than the $300
or more that a person would normally pay, since insurance does not cover the
scans" [emphasis added]

If these tests were required coverage under PPACA they would instantly be three times more expensive. To dispel the myth that individuals can't shop for price, supply and demand doesn't apply to healthcare, or consumerism can't work just because University Hospitals and Cleveland Clinic obviously think there is a sufficient market to offer these services and Cleveland Clinic must think these consumers are price sensitive enough to lower their prices close to University Hospital's instead of charging their full normal price.

Why not unleash this power to cut cost 66% instantly on the 40%+ of healthcare that is not urgent or lacking competition?

Friday, April 27, 2012

Kelley Beloff
recently published an important and fact-filled post on physician reimbursement: specifically,
fee-for-service vs. capitation. I
think this is an extremely important topic on its own, and it’s also important
because it ties to many other key topics in medical delivery and finance –
e.g., utilization management and rationing. I expect we will be seeing much, much more on these
topics. Of course I can’t resist
adding my 2 cents. (Well, it
started as 2 cents. Sorry.)

The Irish playwright
George Bernard Shaw was the author of many sharp opinions in the late-19th
and early-20th centuries - opinions that often stung the comfortable
classes of his time, and can still make us moderns uncomfortable. I
quoted Shaw when commenting on Kelly’s post about capitations:

"That any sane nation, having observed that you could provide for
the supply of bread by giving bakers a pecuniary interest in baking bread for
you, should go on to give a surgeon a pecuniary interest in cutting off your
leg, is enough to make one despair of political humanity."

I think this insight
is noteworthy. It comes from the
100-year-old diatribe that introduced Shaw’s play, “A Doctor’s Dilemma”. Shaw’s point was that fee-for-service
payment is incentive for a physician to do more. But doing more can also mean marginal or even unnecessary
services that, as Shaw vividly pointed out, bring unnecessary risk of injury to
the patient.

We moderns find it
easy to accept fee-for-service, because it is predominant and familiar, and we
perceive it as normal; thus we tend to accept the personal risks that come from
medical treatment. On the
other hand, we find it much easier to object to capitation – because we worry
that capitation provides incentive for our physician to skimp on treatment. Thus we perceive personal risk from
receiving too little treatment ourselves.
This worries us, even as we read research that shows too much treatment
is a general problem, not only for the public health but for the public purse,
too. The difference in how these reimbursement methods are perceived is
important to keep in mind when thinking about their pros & cons.

Another commenter on
Kelley’s post took exception to my quoting Shaw, based on Shaw’s rather
repugnant ideas about what we today call medical rationing. For example, Shaw said this:

"If you can’t justify your existence, if you're not pulling your
weight in the social boat, if you're not producing as much as you consume or
perhaps a little more, then, clearly, we cannot use the organizations of our
society for the purpose of keeping you alive.”

In the intro to
"A Doctor's Dilemma" Shaw stated the same thing another way:

“In legislation and social
organization, proceed on the principle that invalids, meaning persons who
cannot keep themselves alive by their own activities, cannot, beyond reason,
expect to be kept alive by the activity of others. There is a point at which
the most energetic policeman or doctor, when called upon to deal with an
apparently drowned person, gives up artificial respiration, although it is
never possible to declare with certainty, at any point short of decomposition,
that another five minutes of the exercise would not effect resuscitation. The
theory that every individual alive is of infinite value is legislatively
impracticable

Note “organizations of our society” in the first
citation, and "legislatively” in the second. Shaw was talking about what we now call government rationing
of medical services.

I think Shaw
advocated his position for the same reason that the Obama administration advocates
the same position. That is, in order to have an affordable national
medical insurance scheme, there must be some reasonable way to control
spending. Shaw concluded that to control spending the government must deny at
least some medical care. The Obama
administration has reached the same decision. In other words, both concluded rationing is necessary.

NHS rations more
explicitly, e.g., thru "NICE". Other countries ration less
explicitly e.g., the queue. In the U.S. we have rationed largely on
price. But you can be certain that
rationing explains why the Obama administration is trying to sell
Physician Advisory Panels as necessary under PPACA.

Shaw advocated a
national medical insurance scheme in the U.K. 50 years before NHS
arrived. He felt he had suggested a reasonable basis on which to deny
care. This is a very uncomfortable subject. But I ask you:
how can a national medical insurance scheme succeed with limited resources,
if there is no limit to the expenditure of resources on anyone? In other words without rationing, how
can any national medical insurance scheme be “legislatively practical” within
“the organizations of our society” - - to echo Shaw’s terms?

Yet the issue before
Shaw was not simply financial. It
was - and is - a moral and ethical issue, too. This same moral and ethical
issue is present in today's debate about the future of our medical care
system. Advisers to the Obama administration such as Ezekiel Emanuel
(Rahm's brother, btw) sound just as rational - and just as repugnant - as Shaw.
However, it's no use to pretend the rationing issue will not exist if we simply
ignore it, or to pretend we can safely disregard influential points of view
with which we disagree.

If you are
interested, I highly recommend this article: "Principles for allocation of
scarce medical interventions" Govind Persad, Alan Wertheimer, Ezekiel J
Emanuel; Lancet 2009; 373:423–31. A link to this article is found within this earlierInsureblog post.

The Wall Street Journal reported today, April 27, the
estimated amounts of overall 2011 premium rebates required by Health Care Reform. Premium rebates are payable annually by the insurance companies
to their policyholders, beginning this year in August. The reported rebate estimates come from Kaiser Family Foundation. Goldman Sachs has separately estimated similar rebate amounts for 2011.

HHS Secretary The Fair Kathleen opined that the rebate
estimates show the health care law “is already strengthening the health
care system.” We'll see about that, Kathleen.

Keep in mind group policies cover the vast majority of privately-insured people.

For the 7% or so of Americans who are covered by individual policies, Kaiser estimates average rebates of about $10.60 per month per
policy, less than 6% of the monthly average 2011 individual policy premium.

The thanks of a grateful nation are owed to The Fair Kathleen
and The Cool Barack.

The rub here is several fold. First, only fully insured plans are subject to the requirement (as Nate breathes a sigh of relief); since most large employers are self-funded, their plans are exempt (well, for as long as HHS Secretary Shecantbeserious says they are).

Second, we're talking about an average payout of about $127 per policyholder; it's unclear if that's per insured, or just to the premium payer. And don't just assume the latter: with this bunch, no such assumptions are safe.

Third, there's the little issue of taxes: if you're an individual, chances are your refund's going to be non-taxable (unless you've set up a Section 105 plan). But if you're part of a group plan, and your premiums come out pre-tax (such as under a Flexible Spending or POP Account), it appears that you'll be on the hook. And at a measly $127, don't bother waiting by the mailbox for a 1099.

Continuing on for those in group plans, there's the little matter of enforcement. That is, these checks will be going to the employer, not the employees individually. It's up to that employer to distribute the cash. Which presents two more little wrinkles:

How are the employees going to know whether or not that check actually arrived, and how much it was? And how do they make the employer cough it up? Lawsuits for $127?

And from the employer's perspective: how are they supposed to find Sally Jones, who left the company in early 2011? That's over a year before the checks go into the mail, and with our transient society, who knows where she ended up?

"There's
a clear majority who think there is a problem that needs to be
addressed, but (people also believe) if the changes are going to cost me
money in terms of higher co-pays, higher deductibles or higher taxes,
no thank you," said Humphrey Taylor, chairman of The Harris Poll.When
people were presented with nine proposals for slowing the rate of
Medicare spending, the poll revealed strong approval (72 percent) for
cutting the price Medicare pays for prescription drugs to pharmaceutical
companies, and modest support for trimming fees to hospitals (47
percent favor, 28 percent oppose) and doctors (41 percent to 35
percent).

Translation - fix Medicare by making health care companies, hospitals and doctors agree to work for less money.

Sounds like a DC "fix".

Few
favor higher taxes and out-of-pocket contributions, such as increased
co-pays and deductibles. Fifty-three percent and 60 percent,
respectively, oppose those options. But a majority said people with
higher incomes should pay more for Medicare benefits than lower-income
individuals (57 percent favor, 21 percent oppose).

Tax the rich, make the rich pay more for Medicare, but don't ask me to make sacrifices.

Isn't this the way everything in America is these days? Make someone
else responsible. Make them pay. Don't expect me to sacrifice. They
created this problem, not me.

With 49 million on Medicare now
those numbers will grow to 80 million in the next few years as baby
boomer's turn 65 and join the ranks of government health care paid for
by working taxpayers.

Wonder how our children and grandchildren will feel about that?

A
majority of adults (54 percent to 18 percent) polled agree that doctors
and hospitals should be paid based on quality and results, rather than
the volume of care provided. Even in Washington, D.C., Taylor noted,
"there is an acceptance . . . that the traditional fee-for-service way
of paying for things is a kind of toxic incentive and needs to be
changed."

OK, but who determines the standard of care and how do they gauge quality?

Something tells me this Medicare problem won't be solved any time soon, and some folks will not be happy with the solutions.

In some cases, patients who are on Medicare and have a Part D drug plan can still use the services of a PAP. Ask your prescription drug plan carrier if they will help in applying for assistance.Several years ago I became acquainted with these programs and have recommended them to friends and clients. Most are large national companies but some are small and "client friendly."Susan Marx is a former client as well as a friend. I have called on her numerous times to help friends and clients find a way to pay for their medication.SPIN (Special Patients in Need) is a Georgia based Patient Assistance Program with clients all over the country. You do not have to be a Georgia resident to use their services.They can help you find a way to pay for thousands of Generic or Brand name medications.SPIN offers a wide range of public assistance programs for low income individuals including free clinics, free cell phones, home mortgage assistance and more.We invite you to contact Susan at Special Patients in Need if you are on Medicare, or if you are having difficulty in paying for your medications. We've included her website in our "Resources" section in the sidebar.

Regular readers won't be surprised, of course, but it's a great object lesson for those on the fence about the existing safety net's availability and efficacy. In this case, a former lawyer (why am I not surprised?) allegedly lost her health insurance along with her job a couple of years ago.

The story gets fishy after that:

"She bought private coverage for her two children"

Really? From whom? We know that the child-only health insurance market started drying up in mid-2010. Was Ms Ibson one of the lucky few whose kids snuck in under the wire?

The mystery deepens:

"[She] could not find it for herself."

Again, why is that? Was COBRA continuation available from her former employer and, if so, why didn't she take it? She claims that "[n]o one would insure me because of my pre-existing conditions," but offers no explanation as to what they are (were?) or with whom she applied.

Why is that?

And then there's this whopper:

"In fact, Ibson’s current coverage is provided by HIP Iowa, a state program for people whose health problems make them ineligible for most commercial insurance."

The program's been around for some 25 years, so it's not as if it needed any boost from DC. Nor is it a net drain on the taxpayer (unlike PCIP): "Most of the program’s subsidies come from fees paid by commercial insurers."

Heh.

There are two major issues with stories like this: first, that the media laps them up uncritically and second, that they so often turn out to be based on lies (or at least obfuscation).

Jennifer Salopek, blogging at Wing of Zock (which, BTW, would make a great name for a rock band), makes a terrific HWR hosting debut. It's obvious that she's read every post, and offers her own insights to each entry.

Wednesday, April 25, 2012

Shingles
is a painful. blistering skin rash caused by the varicella-zoster
virus. The same virus that causes chicken pox is also responsible for shingles.

The National Library of Medicine has this to say about shingles.

After you get chickenpox, the shingles virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later.The reason the virus suddenly become active again is not clear. Often only one attack occurs.Shingles may develop in any age group, but you are more likely to develop the condition if:

You are older than 60

You had chickenpox before age 1

Your immune system is weakened by medications or disease

If
an adult or child has direct contact with the shingles rash on someone
and has not had chickenpox as a child or a chickenpox vaccine, they can
develop chickenpox, rather than shingles.

There
are shingles vaccines, but they cannot be administered when you have an
active flare up. Two popular shingles vaccines are Zostavax and Varivax.

Your
doctor may prescribe a medicine that fights the virus, called an
antiviral. The drug helps reduce pain and complications and shorten the
course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.The
medications should be started within 24 hours of feeling pain or
burning, and preferably before the blisters appear. The drugs are
usually given in pill form, in doses many times greater than those
recommended for herpes simplex or genital herpes. Some people may need
to receive the medicine through a vein (by IV).Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and the risk of continued pain. These drugs do not work in all patients.Other medicines may include:

Antihistamines to reduce itching (taken by mouth or applied to the skin)

Pain medicines

Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia

Cool
wet compresses can be used to reduce pain. Soothing baths and lotions,
such as colloidal oatmeal bath, starch baths, or calamine lotion, may
help to relieve itching and discomfort.Resting in bed until the fever goes down is recommended.The
skin should be kept clean, and contaminated items should not be reused.
Nondisposable items should be washed in boiling water or otherwise
disinfected before reuse. The person may need to be isolated while
lesions are oozing to prevent infecting other people who have never had
chickenpox -- especially pregnant women.

Your
Medicare Part B covers preventive services, including vaccinations for
influenza, pneumonia and Hepatitis B, but not shingles.

Tuesday, April 24, 2012

As the economy continues to founder, more and more folks find themselves "underemployed." That is, able to find a job or two, but only on a part-time basis. While that may, in fact, put food on the table and keep a roof over one's head, it creates another problem:

That's because, in order to be eligible for group cover, one must consistently work a certain number of hours "on the job." So if you're racking up 20 hours at (for example) Fred's Shoes and another 20 at Joe's Cafe, that 40 total hours doesn't get you benefits at either place.

Here's another little clue that the reporterette missed, by the way:

"[E]ven when the unemployment rate fell between 2002 and 2005, it did not appear to have an impact on employer sponsorship of health plans"

Really? And what happened in 2010 that might have changed this calculus, Allison?

It's been a while since we reported on efforts by some of the 58 states to force life insurers to keep better track of their customers and beneficiaries. Unfortunately, this doesn't mean that said states have been idle in their efforts:

So now it's become the insurance company's responsibility to track down long-lost relatives, and hope against hope that the information in that Social Security database is accurate.

Rotsa ruck with that.

Here's a question: if insurers are now to be required to track down beneficiaries, how come banks aren't required to track down customers with whom they've lost contact? Why is it okay for the states to have the "unclaimed funds" database but not force them to actively find those owners?

"It was announced on April 2, 2012, that the FTC commissioners, in a 3-to-1 vote, allowed the merger of Express Scripts, Inc. (ESI) and Medco Health Solutions, Inc. (Medco), pharmacy benefit management partner for [several carriers]."

Perhaps anticipating the usual glitches, the email included this helpful codicil:

"Please assure your groups and members they should experience business as usual while the two companies integrate."

Having written life insurance on several PC survivors, I'm aware of how much pain and trauma can be involved. And although it's among the most curable of cancers (if caught early on), it's still no picnic.

Well, it better: for almost $100 a pop, "patients" get a "basic IV of saline solution, B vitamins and vitamin C." Another $60 gets a second bag of the magic potion. Door-to-door service is also available (for a fee).

That potion, by the way, also includes a pain-killer and anti-nausea meds.

The service does have certain rules: no alcohol within two hours of treatment, and no service to folks who are still inebriated. Walk-ins and pregnant folks aren't welcome, either.

According to their website, they don't take insurance (and apparently aren't in any PPO networks). One wonders, of course, if the treatment is eligible under HSA, FSA or HRA plans [see update below].

The service is currently available only in Vegas, but who knows: next stop, Atlantic City?

Medicare and an election year. Strange bedfellows to say the least. What could be more tailor made for a re-election bid than playing political football with 12 million voters on Medicare?

Add in a political slush fund that does not require Congressional approval or oversight. Money that is controlled by the department of Health and Human Services. Marvelous (unless you are a senior on Medicare).

As the New York Post reports:

The most oppressive aspects of the ObamaCare law don’t kick in until after the 2012 election, when the president will no longer be answerable to voters. More “flexibility,” he recently explained to the Russians.

But certain voters would surely notice one highly painful part of the law before then — namely, the way it guts the popular Medicare Advantage program.

Still popular, the Medicare Advantage plans have taken hits in recent years causing many seniors to abandon the plans and return to original Medicare and a Medigap plan.

But as part of its hundreds of billions in Medicare cuts, the Obama one-size-fits-all plan slashes reimbursement rates for Medicare Advantage starting next year — herding many seniors back into the government-run program.

Medicare open enrollment is an annual occurrence with floating start and ending dates that generally fall in November and December of each year. The annual election period may start after this years presidential election, but seniors will start to get their Annual Notice of Change several weeks before the election.

But the administration’s devised a way to postpone the pain one more year, getting Obama past his last election; it plans to spend $8 billion to temporarily restore Medicare Advantage funds so that seniors in key markets don’t lose their trusted insurance program in the middle of Obama’s re-election bid.

The money is to come from funds that Health and Human Services is allowed to use for “demonstration projects.” But to make it legal, HHS has to pretend that it’s doing an “experiment” to study the effect of this money on the insurance market

Spend $8 billion to "study" something it is already doing.

A Government Accounting Office report released this morning shows, quite starkly, that there simply is no experiment being conducted, just money being spent. Understandably, the GAO recommends that HHS cancel the project.

Time again for an update on the on-going battle between life insurers and would-be viatical investors. This time out, the Fortress Investment Group bought a thousand "junk" policies in the hopes that at least a few would pay out the big bucks.

What's a "junk" policy, you ask?

Well, it's a new term to me, as well; it seems to refer to policies other investors had dumped on the market as it became more and more apparent that collecting on them was getting to be problematic. There are two diametrically opposed forces at work here: the (bogus) insurable interest issue and the (very real) issue of fraud.

Part of the problem, of course, stems from the fact that some carriers - Phoenix apparently among them - fell on hard times through the last decade, victims of the economic downturn and their own financial strategies. Faced with the possibility of paying out hundreds of thousands, perhaps millions, of dollars, these carriers are fighting tooth-and-nail to hold onto their assets.

Saturday, April 21, 2012

Content Warning: While this is, in fact, a post about a specific type of life insurance claim, it refers to a rather unsettling (and adult-themed) "proximate cause."

Accidental Death policies are something of an enigma to me: the idea that one needs (more) life insurance only if death occurs by accident, as opposed to illness, seems absurd. You either need the coverage or you don't; the bank doesn't care if you die of cancer or gun-shot, it wants its money. Now.

We've touched on this subject before, but a recent ruling by a circuit court opens up a rather, um, unusual can of worms:

Apparently, the late Mr Martin chose to engage in a "specialty" sexual practice, and was electrocuted while so engaged. The Hartford Life insurance company, after investigating the claim, determined that, even though he most likely didn't set out to kill himself, the activity was such that he should have been aware of the possibility (the fact that he was an electrical engineer by trade may have been a clue).

The court, though, made an interesting point:

"The Hartford’s stance “would exclude injuries resulting from merely negligent acts, even if the insured did not intend to injure himself."

A fair cop, really. What if he'd been bungee jumping or skydiving? The principle that these are highly dangerous activities would let the carrier off the hook, right? Heck, driving or flying can be characterized as "dangerous," as well; where does The Hartford get to draw the line?

I'm still not a fan of these kinds of policies, but I have to side with the US Second Circuit Court of Appeals here.

■ On the tech front, Humana's developed a new app "that helps employees make sound healthcare decisions." Over the next few years, according to Humana, more than a half a billion folks will be using their smart phones to help them manage their health care.

Of course hospitals (and any other
provider that wants to stay in business) needs to shore up their revenues, and it doesn't take a rocket surgeon to know that increasing
services and/or locations is the way to go.

What happens when an American doc compares Obamacare to the British National Health Service? It is not a pretty sight:

My time in the British National Health Service in the 1980s was a tremendous learning experience. England still has incredible clinicians who can do remarkable work with scarce resources. The truth, however, is that working at an NHS hospital is like taking a time machine back 20 years. The infrastructure, equipment, surgical tools and medications are backward by comparison to any medium-sized hospital in the United States. The irony is that many nations afflicted with Obamacare systems have moved toward private, decentralized approaches. When teaching medical students about health care economics, I point out that the cell phone revolution began when President Ronald Reagan dismantled the market monopoly of AT&T.

I told you it was scary, yet this is what the American public wants.

Or do they?

I believe that a decentralized, patient-focused approach can work. Health insurance can be less expensive if more insurance companies compete with products that people actually want, not those their employer or the government think they need.

Actually, carriers do provide products that people want.

Cost efficiencies will happen when people use at least part of their own money to pay for health care. Futile, ridiculously expensive end-of-life treatments occur when the bill can be off-loaded onto unsuspecting taxpayers. Lastly, enormous savings will follow reform of the medical malpractice circus.

Copay plans, low deductibles, unlimited doctor visits and small payments for ER visits are quite popular which continues to fuel demand for this kind of plan. High deductible HSA plans, while popular, only comprise around 20% of plans in force.

There is some truth to what Dr. Galyon says, who wants to be the one to tell your terminally ill family member if they want to continue living they will have to absorb the cost themselves?

Malpractice claims comprise a relatively small direct cost that is factored in to health care prices, but redundant testing for CYA purposes is excessive.

What is really fun is when the rebate goes back to an employer who is then supposed to divvy up the rebate among all participants if the plan was contributory. This would include participants only on the plan a few months and those who are no longer employed.

Which is one more nail in the employer-based health insurance coffin. Imagine that nightmare.

Bob also observes:

The rep told me at least one carrier ... is going to charge back any commissions paid to agents an amount equal to the rebates offered on their clients.

As we noted regarding insureds' tax liability, this also opens a major can of worms: that charge-back means that the agent (and his agency, if applicable) will have to re-file the previous year's taxes. OTOH, one supposes this will be a gold mind for the CPA's.

Regarding the recent VEBA post, I did want to mention something else I learned in that class: Short Term Medical plan alternatives.

As Bob noted a while back, Short Term Medical (STM) plans are a convenient and relatively inexpensive way to bridge the gap between coverage (eg new job waiting period) but do have some definite drawbacks.

Thing is, folks are drawn to STM for (primarily) price and simplicity. Most folks can't imagine actually needing to use it (to be fair, most folks don't anticipate "using" their car or home insurance, either); it's mostly "peace of mind" coverage.

For me (and, I suspect Bob), the two major problems with STM plans are that they don't cover pre-existing conditions (especially relevant when one plan expires and a new one begins), and coverage expires when the policy does (with some very specific and rare exceptions).

Still, convenience and price are powerful motivators, and so most of us continue to offer these plans to our clients and prospects.

So what, you may be thinking, does this have to do with that CE class I keep bringing up?

Just this:

The instructor was also very concerned about the pitfalls of STM, and suggested using [her company's low-cost, no-frills] plan. The downside to this method is that underwriting can take longer for this than a STM, but using the electronic application process can significantly shorten the processing time. The pricing on this plan is (ostensibly) comparable to the STM, but this method offers two distinct advantages:

Since it's major medical, you keep the plan as long as you want to (3 months or 30). And if you end up not lasting through the new employer's waiting period, you're all set with insurance while you keep looking.

But there's another, more serious but generally less well known issue: the "active at work" clause. No, it doesn't mean that you're setting new production records. Rather, it means that group insurance plans require you to be actively at work on the first work day of eligibility. This seems innocuous, until you consider what might happen if that first day is the Monday following the weekend during which you totaled your car, and you're still in the ICU: your STM ended Sunday night, and your new group plan isn't in place (you're not "actively at work," are you?).

Creek. Paddle. Some assembly required.

Using the (inexpensive) no-frills major medical plan, however, obviates all of this. Whether or not you're at work on Monday is irrelevant, and you don't have to worry that the plan ends at midnight.